Dorcas Adedoja, MPH
Issue No. 22 • Spring 2021
COVID-19 does not discriminate, and neither should health systems.
Arkansas’ SB 289 and HB 1570 permit blatant trans and queer healthcare discrimination. SB 289 legalizes refusal to treat and provide information to trans and queer patients on the basis of religious grounds.1 HB 1570 denies trans youth affirming care that is supported by the American Academy of Pediatrics, the American Psychological Association, and the American Medical Association.2 Other laws attacking trans healthcare have emerged in roughly 15 other states.3
Gender affirming care lowers suicide risk and improves the overall health of trans youth.4 Trans young people must be protected, especially because of the heavy toll the pandemic has already taken on their mental health.5
The lethality of these bills is undeniable. The COVID-19 pandemic has already claimed over half a million lives in the United States: allowing health providers the ability to decline treating trans patients on the basis of religious grounds is a death sentence.
As COVID-19 vaccine rollout is underway across the United States, permitting further hostility in the health system may cause some trans people to avoid seeking any medical care.
Studies show 30% of trans people report delaying healthcare due to fear of discrimination, and 70% of trans people report receiving discriminatory care from health providers when they did seek medical treatment.6,7 Being a Black trans person compounds the danger in health settings as evidence shows Black people are already less likely to receive appropriate testing and treatment.8
As usual, community is fighting back. Organizations like the Griffin-Gracy Educational Retreat and Historical Center, Intransitive, and the Center for Artistic Revolution are leading pushback in Arkansas with national support.9,10,11 The ACLU recently announced it will be suing Arkansas over HB 1570 as well.12
Health professionals are also rallying against these bills in Arkansas and beyond to make healthcare more equitable.13
Prior to the Arkansas bills, me and Daniel Alohan penned a demand letter to Columbia University’s Mailman School of Public Health in 2020. The letter demanded action to name and address violence Black trans people face in health and policing systems among many other things. While we penned the demand letter together, the views in this text are entirely my own.
Black trans people face high levels of policing in addition hostility in healthcare. 62% report a period of incarceration in their lifetime, and evidence links incarceration to community health decline.14,15 Despite this, Black trans realities are often left out of conversations about policing and detention in the United States. The case of Tony McDade, a Black trans man killed in 2020 by Tallahassee police in Florida, faced similar neglect.16
This spurred a call for collective acknowledgement of the Black community beyond gender binaries and borders as the first demand of the letter. It is impossible to address anti-Black violence with a limited scope of who encompasses the Black community.
Other demands included community investment and the creation of a comprehensive curriculum across the institution to equip the next generation of public health with the education necessary to serve all of the Black community.
The school launched the FORWARD (Fighting Oppression, Racism and White Supremacy through Action, Research and Discourse) initiative in response.117 The structure of the FORWARD program is unprecedented in public health institutions of higher education.
A permanent accountability cabinet structure was created, democratizing dean decision-making power among students. Commitments were made to reimagine school curriculum. Most importantly, funding was permanently allotted to students to give back to their respective communities. This is a step in the right direction to improve the care all Black people, but especially Black trans people, receive in the health system.
The passing of SB 289 and HB 1570 in Arkansas reconfirm shifts in higher education alone will not be enough to transform healthcare. There remains much to be done to quell the routine assault on the lives of trans and queer people, with emphasis on those who are Black. All hands must be on deck to overcome policing, attacks on trans health, and the COVID-19 pandemic.
ACLU of Arkansas, “ACLU Of Arkansas Statement on Legislature's Passage of Broad Health Care Refusal Bill,” ACLU, March 15, 2021, https://www.aclu.org/press-releases/aclu-arkansas-statement-legislatures-passage-broad-health-care-refusal-bill
ACLU of Arkansas, “What You Need To Know About The Transgender Health Care Ban (HB1570),” ACLU, March 23, 2021, https://www.acluarkansas.org/en/news/what-you-need-know-about-transgender-health-care-ban-hb-1570
Chelsey Cox, “As Arkansas bans treatments for transgender youth, 15 other states consider similar bills”, USA Today, April 8, 2021, https://www.usatoday.com/story/news/politics/2021/04/08/states-consider-bills-medical-treatments-transgender-youth/7129101002/
Lisa Rapaport, “For some trans youth, suicide risk lowers with puberty suppression”, Reuters, January 23, 2021, https://www.reuters.com/article/us-health-puberty-transgender/for-some-trans-youth-suicide-risk-lowers-with-puberty-suppression-idUSKBN1ZM311
Deborah Brauser, “Suicide, Depression, Anxiety: COVID 19's Heavy Toll on Youth”, Medscape, September 25, 2020, https://www.medscape.com/viewarticle/938065
Daniel Trotta, “Transgender patients face fear and stigma in the doctor's office”, Reuters, September 15, 2016, https://www.reuters.com/article/us-usa-lgbt-medicine/transgender-patients-face-fear-and-stigma-in-the-doctors-office-idUSKCN11L0AJ
Lambda Legal, “When Health Care Isn’t Caring”, Lambda Legal, 2010, https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring.pdf
Marya T. Mtshali, “How medical bias against black people is shaping Covid-19 treatment and care”, Vox, June 2, 2020, https://www.vox.com/2020/6/2/21277987/coronavirus-in-black-people-covid-19-testing-treatment-medical-racism
https://www.littlerock.com/little-rock-destinations/center-for-artistic-revolution-(car4ar)
ACLU, “ACLU Statement on Arkansas Legislature's Vote to Override Veto of Transgender Health Ban,” ACLU, April 6, 2021, https://www.aclu.org/press-releases/aclu-statement-arkansas-legislatures-vote-override-veto-transgender-health-ban
Mills Hayes, “Arkansas healthcare workers speak out against trans medical bill, supporters hold steady”, ABC7, April 4, 2021 https://katv.com/news/local/arkansas-healthcare-workers-speak-out-against-trans-medical-bill-supporters-hold-steady
Center for American Progress, “Unjust: How The Broken Criminal Justice System Fails LGBT People of Color”, American Center for Progress, August 2016, https://www.lgbtmap.org/file/lgbt-criminal-justice-poc.pdf
National Research Council. “The Growth of Incarceration in the United States: Exploring Causes and Consequences”, 2014, National Academies Press, https://www.nap.edu/read/18613/chapter/15
EJ Dickson, “Another Black Man, Tony McDade, Was Shot and Killed by Police Last Week”, Rolling Stone, June 1, 2020, https://www.rollingstone.com/culture/culture-news/tony-mcdade-shooting-death-tallahassee-1008433/
Columbia Mailman School of Public Health, “Columbia Mailman School Commits to Becoming an Anti-Racist Institution”, Columbia Mailman School of Public Health, November 10, 2020, https://www.publichealth.columbia.edu/public-health-now/news/columbia-mailman-school-commits-becoming-anti-racist-institution
Dorcas (they/them) is a 2020 Human Rights Campaign ACTIVATE Fellow, DotDash Anti-Bias Review Board Member, and Columbia University Mailman School of Public Health FORWARD Accountability Cabinet member.
Dorcas is confident the skills they have acquired through their public health coursework, grassroots organizing experience, and intern experience in the New York City Department of Health's Epidemiology Administration during the first wave of the COVID-19 pandemic make them an advantageous entrant into any environment interested in developing equitable strategy to thrive in the post-pandemic atmosphere.